South Carolina Governor Henry McMaster COVID-19 Briefing April 6

Henry McMaster: (00:00) We all thank you for coming, today again we are trying to be sure that everyone is kept up to date on the progress of the virus and the progress of our efforts to fight that virus without destroying jobs and families. So today I am issuing another order, this is a mandatory order. We've issued several that contain mandates and others that contain recommendations. Today most of those recommendations of becoming mandates, becoming orders with criminal penalties attached. I'm issuing a mandatory home or work order. A home or work order that goes into effect tomorrow afternoon, Tuesday at 5:00 PM close of business. Everyone under this order, everyone should stay home unless they're working, they're visiting family or recreating outdoors, unless they obtaining necessary goods or services. And those are the limits, that we are closing no additional businesses. Those businesses have been closed in previous orders. Also, we're requiring mandates of the retail stores that are open and that is they must limit the customers. Henry McMaster: (01:24) We must have social distancing in these stores and that specifically is no more than five customers for every 1000 square feet in a retail business or 20% capacity according to the fire marshal, whichever is less. A violation of any of these mandatory requirements is a misdemeanor 30 days in jail and or $100 fine for each day of violation. Why are we doing this now? Why not wait later? Why not have done it earlier? That is because it is time according to the data, according to the science, according to the facts and according to the expert advice and guidance as we have explained before, it is now time to make these recommended actions required. Why is it time? Because too many people from the statistics, from the facts, from observations, too many people are on the roads, too many people are on the waters, too many people are in the stores, too many people are not requiring with our requests concerning social distancing. Henry McMaster: (02:45) We've asked, we've urged, we've suggested, the experts have suggested, everyone is aware of what we have, the information that we have disseminated, but the week or so has shown that it's not enough. The rate of infection is on the rise and the rate of noncompliance is on the rise. We hope that this order today will reduce the rising rate of infection and also reduce the rate of noncompliance and also reduce the number of people who are losing their jobs because of these necessary orders. This week, ladies and gentlemen we had over 200 this week. By the end of this week, we expect to have over 200,000 people who have applied for unemployment insurance in South Carolina. That's just the tip of the iceberg. Each one of those 200,000 people likely represents a family and we know there'll be more. We know that many more than that that have lost their jobs either because of the market, because of steps taken by businesses and services or by the orders that we have issued. Henry McMaster: (04:07) All of those people have to pay bills, they you have to feed their children, they have to save for college. There are many things that people will not be able to do because of these orders it'd be difficult at the least. So we must be aggressive in going after this virus, but we must seek to do as little damage, as little destruction to the homes and the businesses and the people and the jobs as is possible. Finally, as for the general assembly, as you know we have to have a budget, we have to have laws, we have to have business done in the general assembly. So I'm urging the general assembly to come back to work on Wednesday as has been planned and get it done. We have cashiers going to work. We have police officers going to work. We have all kinds of people going to work. There's no excuse for the members of the general assembly not to come to work on Wednesday and take care of this vital business. Henry McMaster: (05:15) And finally again on Easter services we recommend that those services continue of course, but we urge the churches and others to stream on the internet if they can, to meet outdoors if they can and if they can't do those, please provide for that social distancing in the church. Now speaking of Easter, would the chaplain please come forward? Speaker 3: (05:48) I want us to remember a few words from the preamble of the constitution. This says we the people of the United States in order to form a more perfect union, establish justice, ensure domestic tranquility, provide for the common defense, promote the general welfare and secure the blessings of Liberty to ourselves and our posterity. If you would please pray with me if you're a praying person. Great God, you are a God of unity, a God who requires us to love justice and who longs for peace and mercy amongst his people, during this time help us. We the people of the United States continue to love one another, serve each other and let the spirit of South Carolina and America shine through us all as we patiently obey and pray for the leaders over us and pray for the healthcare workers and other servant leaders selflessly tending to our needs. I pray all these things in your mighty name. Amen. Henry McMaster: (06:55) Dr [inaudible 00:06:55] Speaker 2: (06:59) Thank you governor. Good afternoon everyone. We are reporting 183 new cases of covid-19 as of today, which brings the total number of people confirmed to have the disease in South Carolina to 2,232. Over the last week we have seen an accelerated rate of new infections in South Carolina. An average of 187 new infections per day have been reported in the past week. That is an increase from an average of 90 new infections per day being reported in the week prior. We recognize the hardships that are facing many South Carolinians as we continue to respond to this public health threat together. I want to reassure the public that we are working hard together as a team from the local state and in concert with our national partners to protect the health and safety of all South Carolinians. Speaker 2: (07:59) And as of today, we continue to work with healthcare facilities to stay updated on the availability of acute care beds throughout our state and currently we are at 51% capacity. A total of 21,384 tests have been performed by both the DHEC public health lab and private labs on South Carolinians in our state of which 2,232 or approximately 10% have been positive. While our state's public health laboratory has no delay in testing, private laboratories around the nation have significant delays which would indicate an even higher number of cases yet to be reported and we should also include individuals who may not be tested. We are working to avoid the problems that the most impacted areas are seeing related to the stress on the healthcare system, including hospitalization rates, ventilator availability and others. And we are doing this by prioritizing our limited resources. Speaker 2: (09:05) Our current data shows us that social distancing and staying home helped combat the spread of disease and ultimately save lives. However, while these hard hit areas of the country are continuing to have significant daily mortality, it puts us in the best position if we plan for the worst. The daily case counts in some of those areas is improving due to strong mitigation efforts and we've worked in consultation with the governor to implement effective measures to slow the spread of the virus. Our ability to combat the spread of the disease will depend on the actions that each of us takes. This is a historic and unprecedented event and how we respond as individuals, a community and a state will be remembered for generations to come and we ask for your continued support for following the guidance of public health professionals so that we can continue to fight on your behalf. Please do your part, stay at home and limit close contact with others. And as always for the latest information, please visit our webpage scdhec./covid-19. Thank you. Henry McMaster: (10:16) Thank you doctor. Director Davidson. Director Davidson: (10:19) Thank you, sir. Thank you governor. I'll briefly cover a few items that will be posted on our website later today both an explanation and a video. Earlier this weekend, the CDC released information regarding the use of cloth masks and face coverings. While these measures are optional, they may help reduce the spread of the virus. They're not intended to replace social distancing or hand-washing or any of the other recommendations intended to protect health. South Carolina residents should not run out and buy masks. As a reminder, the CDC has warned that this is a historic and unprecedented outbreak and that supplies are limited. It is important that we save the manufactured masks, be they surgical masks or N95 respirators for doctors, nurses and first responders who may need them most. Home made masks may reduce the amount of virus that one breathes out and may prevent one from touching the nose or the mouth. This measure is recommended to be used in situations where social distancing may be difficult to maintain, such as grocery stores, pharmacies. It's intended to protect others from those who may be infected with the virus and able to spread it, but not yet showing symptoms. People wearing masks should not feel a false sense of security as well. This means that masks should be worn to help protect others. It's important to understand that these recommendations do not allow for someone to go out in public if they are ill. They still need to practice social distancing, stay at home if you're ill. Individuals with symptoms should continue to isolate at home, but may consider a homemade mask when leaving to get medical items if a homemade mask is all they have. Director Davidson: (12:19) Again, we will post on our website instructions and a video for making a homemade mask. It's quite simple all you need is a piece of fabric. You can take the fabric and fold the fabric so that it fits over your mouth and nose. On one end of the fabric you cover it with a rubber band about two inches from the end of the fabric. You do the same on the other end of the fabric, about two inches down. You then overlap the fabric on either end, grab the rubber bands and then pull it to the nose and mouth. Again that video or a video similar to that will be posted on our website as well as written instructions as to how to make a homemade mask. Thank you. Henry McMaster: (13:11) [inaudible 00:13:13]. General: (13:18) Thank you governor. Since the announcement of the governor masters executive order issued on March the 17th the South Carolina national guard has been working with a strong coalition of personnel comprised of various state and federal agencies and our healthcare professionals here in the state of South Carolina to determine the possible impact that the current covid-19 response plan could have on our health care system here in the state. We have implemented a scalable, tainable, tiered response to increase the bed space, staffing and other support services needed to operate a medical facility. And I like to briefly discuss what our analysis has revealed and the fundamental aspects of this plan. General: (14:04) This tiered response plan is intended to operate within the existing hospital healthcare system in the state. It merely expands the hospital footprint outside of the existing hospital facilities.I'd like to recognize some of our participants that have been a part of this process. South Carolina emergency management division, South Carolina department of health and environmental control, South Carolina national guard, South Carolina hospital association, South Carolina labor licensing and regulations, our regional healthcare providers, South Carolina department of transportation, South Carolina parks, recreation and tourism and the South Carolina department of administration. All of those in addition to others to include the army corps of engineers have been a part of developing this plan that we are prepared to begin implementing as a- General: (15:03) This plan that we are prepared to begin implementing as of now. As we have heard from reports from Dr. [Bell 00:15:09] and others from DHEC over the last couple of weeks, that this pandemic is an ever moving target. When I say that, the projections and the numbers that we're looking at have changed and we anticipate they will continue to change. But we're planning our initial plan, which is again scalable and tailored to the needs that we may have. Our early projections have it that we would have approximately 3,500 potential Covid patients here in South Carolina that could need hospitalization in the early part of May. Again, we will each and every day look at the projections, we will look at those numbers and we will adjust the plan as necessary to be sure that we're capable of handling the response plan as identified that we will discuss here. General: (16:04) Based on today's numbers, you can see the hospital bed space capacity in the state by regions in the Pee Dee, the upstate, the Midlands, and the low country. You can see the numbers that are currently beds that are used and the current beds that had been made available and we have noted in the past that the hospitals have reduced elective surgeries and other procedures to allow that capacity to be there and we appreciate their efforts to do that. General: (16:36) In addition, as we look at it, you can see the number of intensive care capacity we have, the beds that are currently being used for ICU patients and those that are available, and the number of ventilators that are being used and those that are available. Again, these numbers will change potentially on a daily basis and we will always monitor those to ensure that our plan accommodates those. General: (17:02) As of today, we have 5,944 hospital beds that are available here in South Carolina. What our plan will allow us to do is to add an additional 3,000 beds to give us an approximate number of 9,000 beds no later than May 5 of this year. From that planning projection standpoint, in our first phase, by April the 28th, we will add 1,500 beds in either a tier one or a tier two capacity. And we'll speak a little bit more in to that detail to identify what a tier one and a tier two facility will be comprised of. By May 5, we will add another 1,500 beds that will give us that 3,000 bed capacity above and beyond what we currently have available. General: (17:57) Some key takeaways from this, just want to say that this is a contingency plan. This is a plan that we will have in place ready to go if those needs do develop. It's a plan that's built around the current hospital system that we have in the state, in the upstate, here in the Midlands, in the low country, the Pee Dee, and throughout the state. It's a plan that has been vetted by the South Carolina Hospital Association and by the Office of Rural Health, where they have gone and talked to all the leadership in every hospital in the state. The members of the leadership have indicated that they understand the plan, they believe the plan is workable, and they support the plan, which I think is very important. I will now like to have Dr. Eric Ossmann to come and speak to talk specifically how our tiered plan will be implemented. He is the vice chair of the Department of Emergency Medicine and chief of preparedness and emergency management with Prisma Health. At this time, Dr. Ossmann. Dr. Eric Ossmann: (19:09) Thank you, [inaudible 00:19:10] general. So what I wanted to do is just build upon what the general just said about the tiered response plan. When we envisioned this plan, it was to really extend the capacity of our existing healthcare system. We're not making anything new or novel. These are simply extensions of the existing systems. So over the last three weeks, we've been working with the South Carolina Guard, with the Emergency Management Division, with the South Carolina Hospital Association and all of our other clinical partners throughout the state to come up with a workable system that is going to give us the bed capacity that we could potentially need. Dr. Eric Ossmann: (19:46) So this is a three tiered system. And as I'm sure you're very familiar with, the tier three hospitals are your traditional hospitals. They are the hospitals where we provide critical care services, they're the hospitals where we're able to provide ventilatory management to patients that are very sick, and the role of these hospitals is not going to change. These are going to be the facilities that are going to care for folks that are sick from COVID-19, but they will also continue to care for people that have all of the regular illnesses and injuries that people in South Carolina will encounter. Dr. Eric Ossmann: (20:21) So when we look at the additional expansion, we're really talking about tier one and tier two hospitals. And so the idea behind these hospitals is that we will use them to provide treatment within their scope. So we're going to be in the tier two hospitals providing care that is appropriate for those patients. It won't be as intense as we're going to provide in tier three, but it will be professional, high quality care on the level that South Carolinians will expect. The tier one facilities we're really using for quarantine and isolation folks. As you know with COVID-19, one of the most critical things is that people are isolated from others when they're ill and that people that are high risk contacts are quarantined and away from others when they're potentially infectious. Dr. Eric Ossmann: (21:14) So when we talk about these medical surge facilities, what we're really talking about is opening some of the shuttered hospitals, creating tier two facilities in coliseums and arenas, and then also creating tent hospitals if needed. So all of these are options on the table for the tier two facilities. Dr. Eric Ossmann: (21:36) The tier one facilities are really designed for people that are going to be able to provide self-care. So these are not folks who are going to require intense medical treatment. They will require self-care, and we will have a light medical footprint at the tier one facilities to assist and to monitor those patients. Should they become worse, they'll be transferred as they would during any other event to a regular tier three hospital for evaluation and treatment. So we believe that this tiering of our hospital resources will allow us to increase our capacity and serve our patients appropriately and safely during the COVID-19 pandemic. Thank you. General: (22:16) I would now like to ask Dr. Pat Cawley, he's the CEO at MUSC, and his a position there is the vice president for health affairs, where he will discuss some of the staffing challenges that we faced as we work to build this surge plan. Dr. Cawley. Dr. Pat Cawley: (22:40) Thank you general, governor. This plan, on behalf of actually all South Carolina hospitals, I just want to briefly state that we feel we are ready. Just want to support what Dr. Ossmann said in terms of all hospitals have been surveyed in the past few days and every single one of those hospitals is supportive of this plan. It is easy to support because this is a mere extension of what our normal emergency operations plans are. In normal emergency operations, we are ready to surge. This one may be a little deeper and a little greater of a surge than usual, but we are ready. I've seen a lot of work across South Carolina hospitals over the past four weeks, and I am confident that we will be ready. Dr. Pat Cawley: (23:28) On behalf of MUSC, we know this is going to be tough. This is not going to be easy. We have a hospital that normally has about 800 patients in it. We are ready to surge that hospital approximately another 150 beds. To go beyond that, into the second level facility, we are going to use our fitness center, which is about a block away from the hospital, to surge another 250 beds if needed. Once again, this will not be easy. This will require a different level of personnel and how they are used, but we think we are ready. We've been planning and planning hard. Dr. Pat Cawley: (24:07) This is going to take our nurses, our frontline doctors, our residents, our fellows. This is going to take an entire team to take care of these patients, but I feel confident that we are ready. It'll be a tough month. The surge is likely to last a while. It won't go away right away, but I think we can pull it together and I'm confident that based upon what I'm hearing across all of our South Carolina hospitals, that those hospitals will be ready to work individually as well as together. So once again, I think the message is I think we're ready. It's not going to be easy, but I think we're ready to deal with this when it comes. Thank you. General: (24:46) Thank you, Dr. Cawley [crosstalk 00:09:49]. I would like to ask Mrs. Emily Farr with Labor, Licensing and Regulation to come up and discuss their role in the plan. Emily Farr: (24:58) Thank you, general, governor. At the South Carolina Department of Labor, Licensing and Regulation, we are prepared to support the hospitals in this plan through the licensing and credentialing of qualified healthcare workers to build staffing capacity when and where it may be needed. Since the beginning of South Carolina's first response to the pandemic, the agency and its licensing boards has been working tirelessly to take measured responses and adopt incremental flexibilities to ensure that South Carolina has the resources to combat the virus while still ensuring that citizens are provided with appropriate care and benefit from those flexibilities. Emily Farr: (25:40) So for example, in conjunction with DHEC, the agency waived all state licensure requirements for doctors, nurses, respiratory care practitioners, and physician assistants licensed in another state. This allows additional healthcare workers to come to South Carolina and also serves to expand the use of telemedicine to serve our citizens. We have relaxed regulations so that providers from neighboring states can continue treating South Carolina patients via telemedicine. Emily Farr: (26:10) The Board of Medical Examiners has relaxed regulations related to telehealth to expand availability of medical care. This has allowed doctors, physicians, assistants, and nurse practitioners in certain circumstances to write schedule two and schedule three medications via telemedicine without first getting approval from the medical board. It has allowed hospice providers to conduct telemedicine examinations in lieu of traditionally required in-person examinations of patients within 14 days of prescribing medicines for them. It has expanded the ability for the use of telemedicine to treat individuals with opioid use disorder with medication assisted treatment. We've also expanded access to healthcare through telemedicine by expanding telehealth to other professions such as optometry, dental, speech language pathology, physical and occupational therapy, and telecounseling for counselors and therapists, to name a few. We have expedited emergency temporary in state licensure for the board of nursing and the board of medical examiners. Emily Farr: (27:20) The agency has also taken measures to help the licensees themselves that are out there on the front line to help us combat this virus. Many continuing education requirements required by professionals are now allowed online. They have extended any renewal or continuing education requirements for our licensees to September 30th, 2020, given nursing schools full discretion to allow all nursing clinical hour requirements to be done by simulation so that those students could still graduate. We have relaxed other in-person school requirements to allow students to continue the path of earning a professional license. We have also issued practice guidance to licenses from the boards that are provided through links on the website, on the agency's website, to help those practitioners practice safely. All of these measures are available on our website, llr.sc.gov. There is an alert at the top of the page that one can click on and see actions by every board and every area within the agency to help with this pandemic. That link is updated every day as new measures are taken to combat this pandemic. Thank you. General: (28:37) Governor, that concludes. Henry McMaster: (28:38) Thank you. General: (28:38) Yes sir. Henry McMaster: (28:39) Thank you, general. Thank you Mrs. Farr. Well as you can see, we have the whole team on the field, public and private. And I want to thank these doctors and their staffs, the nurses and physicians, all those who are on the front line. It's much like a war. They're there on the front line. Law enforcement, same goes for them. There they are rushing into situations that could be very dangerous to their health. Henry McMaster: (29:06) But represented here today and displayed is the large part of the effort that we're making in public health but also unrepresented today are some you've heard from before, and that's the Department of Employment and Workforce, as well as the Commerce Department, as well as the Department of Mental Health. We know that the isolation that is fostered by these orders in this pandemic are going to exacerbate existing problems and create more. Again, I repeat, we are going to have more and more people that are out of work for various reasons, but we are working around the clock to see that all the resources available to soften that blow, that economic blow, to protect those families, protect those jobs, and get the people back to work when the time comes are being taken. We are taking measured deliberate steps. Everything you've seen here so far has been a part of a plan that is ... Henry McMaster: (30:03) You've seen here is so far has been a part of a plan that is working and is expanding and there will be more steps taken in the future. So are there any questions for anyone? Speaker 9: (30:13) [inaudible 00:00:30:13]. Henry McMaster: (30:13) Yes ma'am. Speaker 9: (30:14) Your office has said that you've questioned the constitutionality of a governor's ability to tell people to stay home. What do you think of that now? And I mean, how has your thinking on that evolved? Henry McMaster: (30:24) Well, I think the same of the constitutionality of such orders that restrict the liberty and rights of people that are protected by the United States Constitution. They are there for a reason and there for situations such as this so that we don't forget. You know, of course, personally I've been a lawyer for ... practicing attorney for 44, 45 years. Several years as US Attorney and several years as attorney general. Henry McMaster: (30:54) What you can do under the law ... What the government can do is ... and we're doing that in this situation. We want to be sure that what we're doing is within the framework of the constitution and the law. And that is to protect the people, having full regard for due process, their rights of assembly, their right to travel, but to stay within the parameters and the guard rails that are set up by the constitution. We have a South Carolina Constitution as well. There's a right to privacy. So what we're doing is limiting the impact of what we're doing as much as we can in order to protect the health of the people that we know is protecting their health, without going beyond that and destroying more that we are protecting while still sticking with the mandates of the constitution. Henry McMaster: (31:44) So the evidence and the facts that have been referred to today, that is the rising noncompliance, the rising infection rate, such things as the CDC now in the last few days recommending face masks, such things about a week or so ago of CDC declaring certain states travel advisories, and certain domestic travel advisories in certain states. Henry McMaster: (32:11) All of those things are leading to a point to where it is within the constitution to use limited ... don't go any farther than necessary to protect the liberty of the people without depriving them of their rights, and that's what we've done today. I'm confident that what we're doing today is legal constitution and is similarly protecting the people without destroying families. Speaker 9: (32:40) As a follow up, why not just call it a stay at home order? You called it [inaudible 00:32:42]- Henry McMaster: (32:41) Well, it is, we've been urging people to stay at home from the very beginning. We've been urging, we've had it on 77 signs that we have on the highways. I think we've said that and this is a stay at home order. You call it what you like, but it says stay at home, work and home, home and work. Those are the best places to be. There are certain other exceptions that are good for the health of the people, but will not endanger their health. Those are the things that we've been espousing and promoting from the very beginning. Yes, ma'am. Speaker 10: (33:16) Governor, you encouraged churches to do their services online, while a church in Charleston held a service yesterday, more than a hundred people who are not social distancing. The pastor said it's his constitutional right to keep it open until the governor says otherwise. Are you going to ask to stop the service? Why or why not? And does this constitute a danger to the public safety? Henry McMaster: (33:32) I can't speak for other governors but this governor is not going [inaudible 00:33:37] on the First Amendment. That is an absolute right. We are encouraging pastors and others in any house of worship, any congregation of any kind to use social distancing, that is go online. Peg and I go online with the First Presbyterian church in Columbia. It's a little different because you don't have the whole choir singing and aren't but three or four people in the church. It's a big church but it works, it's good but do it that way or have the service outside with social distancing or if you must have a congregation under a roof, then use that social distancing. But that First Amendment right is very important. Just like the others and we're respecting that. Speaker 11: (34:20) Governor, how are you all expecting to enforce this new mandate for folks [inaudible 00:00:34:25]- Henry McMaster: (34:26) It is a crime to violate it. It is a misdemeanor punishable. It is a crime, punishable by 30 days in jail, up to $100 for every of violation. Any law enforcement officer can enforce it, just as any law enforcement officer can enforce the three or more rule. That is, if there are three or more people that are congregating that are in one way or another or violating the or ... Excuse me, endangering public health or the public order, they can be arrested and go to jail and pay a fine every time they do it. Same thing on the water, we had just in the last weekend, we had the Department of Natural Resources was out in force on our waterways, which I mentioned earlier. They busted up over I think 2,500 boats that were out on the water and gave a number of citations as well. Henry McMaster: (35:20) Ladies and gentlemen, we got to follow the rules. We know what the rules all, they're clear, the orders we've issued are clear. What you've heard from these people today is clear. We have to do it. If people do not comply, then we'll take the next step and we'll take the next step after that, if necessary to protect the people. That's what we will do. We're not going to violate the constitutional rights, but we are certainly going to protect the people with the limits of the power and resources that we have. Speaker 12: (35:48) Governor, at what level do you want to see motor traffic actually be [inaudible 00:35:53]? What percentage of the normal amount? Henry McMaster: (35:56) You can get the percentages of what's happened in the last weekend from the Department of Transportation. That was part of our consideration for today, where in some places some highways, not interstate highways, but measuring the other highways, traffic actually went up over what's usual, went up 25% in some places. Henry McMaster: (36:19) Well, that tells us that there's a level of noncompliance. People must be ... they're traveling, they're moving around. Those kinds of things added to this increased ... the increasing incidents of the reports and those are just the ones that we know about, that doesn't count those cases out there that we don't know about. All those things added together say that we have to do something. Precise percentage, there is no precise percentage, but we want to see it go down. We don't want to see it go up. We want to see the people that are reducing their interaction with others and the chance for contact and spread of disease to go down and that's what must happen if we're going to stop this fire. It's easy to do. All you have to do is follow the rules that we have laid out, follow the rules that we've discussed every time we've been here, including stay at home as advice and now stay at home as a mandate punishable by law under the rules that we're announcing today. Henry McMaster: (37:18) If everyone will do that, will be serious about this and do that, then the rate of infection will be reduced. Perhaps we won't get to the worst case scenarios that we've talking about and prepared for. By the way, we've been preparing for this for weeks. This is a part of our plan. Maybe we won't get there. We hope we won't get there, but if people don't take it seriously, we will get there. Henry McMaster: (37:41) [crosstalk 00:37:43]. Yes, sir in the back. Speaker 13: (37:44) Arenas were mentioned as possible surge hospitals. Henry McMaster: (37:47) I'm sorry, say what- Speaker 13: (37:48) Arenas have been mentioned as possible surge hospitals. Have arenas like Colonial Life Arena been contacted? Henry McMaster: (37:53) Everyone has been considered. We've had people volunteer. I think the plan that has been announced, I don't know if that includes any arenas at this point. General: (38:03) We are certainly looking at those. We've [crosstalk 00:38:06] to date 18 facilities around the state and the these facilities that have either been the owners or those that operate the facilities have either come forth and says these facilities would be available or the facilities that the state has some type of operational control over. We look at each facility and we have to vet it against certain criteria. We're utilizing the Army Corps of Engineers and they're doing this throughout the country now, but we're utilizing some guidelines that they have in place. We're using engineers from Department of Transportation, from the National Guard and from the State Guard. Facilities generally have to be ADA compliant. They have to have an adequate restrooms and shower facilities. However, we can contract and put those in place if that's necessary. They must have appropriate fire suppression systems. They must be free from lead and asbestos contamination and generally all hotels that we are looking at that are built after 1990 meet that criteria and they have to have emergency backup power and we can also contract or have that type of resource made available. General: (39:13) But we're working throughout the state. We're looking to have in each of those areas identified earlier, at a minimum one tier one and one tier two facility, but we will certainly expand those as needed to accommodate what we believe may be spikes and surges. But we will look to see where we need those facilities built. We also have at our disposal basically hospital tents that are available to us. The state is contracting for 100 hospital bed tent and through DHEC they have other hospital tents that can help expand that capacity. That's a fairly quick turnaround that we can identify an area that may need some immediate assistance and we could have that up and operational fairly quick. Any fixed facilities, we will be working through the Corps of Engineers to determine what those needs are and those will take the greatest lead time. So we'll be moving quickly to determine where those will be and get started on those facilities. Speaker 15: (40:10) Who's going to staff your hospitals? Henry McMaster: (40:10) Did that answer your question? Speaker 13: (40:14) Do you know if Colonial Life Arena is one of those that have volunteered? General: (40:16) I don't know specifically. I've called Colonial Life, but we have had a number of facilities throughout the state that have offered up and we will be conducting assessments throughout the state over the next few days to determine what our needs are and capabilities are based upon the plan. Henry McMaster: (40:30) Anymore questions for the General? Speaker 9: (40:30) Yes, as a follow up to the shuttered hospitals that you might reopen, which hospitals are we talking about and will those be solely for the tier one self care or how will they be used? General: (40:41) We have four facilities that were recently shut, I say recently over the last few years. Two of those facilities are not going to be available to us due to either having been repurposed or we found unacceptable levels of mold in one. The other two will be ... continue to be looked at and no final decision at this point has been made on whether we will use that as part of this plan. Speaker 9: (41:02) Can you say which two? General: (41:04) Excuse me? Speaker 9: (41:04) Which two? General: (41:05) I think it's the Fairfield and the Marlboro that are still potentially on the table. Henry McMaster: (41:09) [crosstalk 00:41:12]. Anymore questions for the general? Speaker 15: (41:12) Yeah. Who's going to staff these hospitals when they open up? General: (41:16) The staffing as identified by Dr. Cawley ... All of this will be done within the framework of the current hospital system. Any support type needs that may be necessary to build up these external facilities. Assets such as the National Guard could be available to help with that. We can contract some of those facilities or some of those capabilities as needed, but we will work within the framework primarily of the existing hospital systems for the actual care itself. The other support systems that are necessary to run a facility may be brought on by other classes, the guard or contract. Speaker 15: (41:53) Is 3,500 that's a worst case scenario for the state? General: (41:56) That is a mid range projection and we will continue to look at projections each and every day. As we look at that and I certainly ... Our system is scalable and if you look at that number based on the current availability of hospital beds, we are confident that we can meet that, but we want to have that contingency available in case those numbers do exceed what we are currently planning and working against. Speaker 9: (42:22) You mentioned that 9,000 beds by May 5th, so is that ... that is when the three tier program will go into effect? [ inaudible 00:12:30]. General: (42:30) Well we are actually have started that now when Dr. Cawley mentioned what they have done it in USC, that process has already started and all of the facilities around the state have been actively working to enhance their capability to expand within their current footprint and I talked with Mr. Thornton Kirby with the Hospital Association and with Dr. Adams. Just want to point out, this is not an unusual operation that hospitals do. In the past five years with the hurricanes that we've had, this type of plan has been used before. What we're doing different here now is just using some additional facilities to help expand on that footprint. For planning purposes, we'd like to have these tiered facilities within a reasonable geographic space of the primary hospital and for planning purpose we've used five miles, but that number was just arbitrary to get us started, but certainly as to needs may exist and what the hospital is better capable of supporting, we will adjust our plan to suit those needs. Henry McMaster: (43:36) A few more questions for General. Speaker 15: (43:39) The 35- Henry McMaster: (43:40) Right here. Speaker 16: (43:41) Go ahead Sean. Speaker 9: (43:42) Well, it's actually sort of a joint question. We're talking about needing a lot more medical staff and we're gearing up and yet we're being told that hospitals are laying nurses and other people off. So how are we going to staff these geared up facilities? Henry McMaster: (43:55) Dr. Cawley? Dr. Cawley: (43:58) Well, I can speak on behalf of MUSC only at this point. It is true that this event, this COVID-19 is affecting the entire economy and it's affecting hospitals and health systems in two ways. That in one way we're being dealt with significant financial challenges. In another way, we're having to deal with the large surge of patients coming. At MUSC, we're going through this adjustment right now. It is not ... what we're doing, the adjustment we're going through will not affect frontline nurses, frontline doctors. What we're doing to make that adjustment is particularly support staff that at this point in time we feel don't need to be part of that surge. And so those are the staff predominantly affected. So once again, I'll just reemphasize, this is not affecting frontline nurses, nursing techs, respiratory therapists, or anybody that provides direct patient care, including our doctors as well. Speaker 11: (44:56) So those staff members would not be laid off or furloughed? Dr. Cawley: (45:00) That is correct, but those staff members have already been- Dr. Cawley: (45:03) That is correct. But those staff members have already been affected by this. Right. And they've been affected by this because of the great decrease in hospitalizations, surgeries, ambulatory visits. They typically flex to volume. And they have been affected in that the number of shifts they may be covering in the last three weeks has greatly decreased. Now that may be okay because in the next four to six weeks they're probably going to greatly increase. So there's been this period of time where the number of shifts that they typically work is down. But it'll go much higher in the next four to six weeks. Speaker 19: (45:35) Is it possible then they could be hired back after very temporary layoff? Dr. Cawley: (45:40) Well, I'm going to reemphasize. We are not laying off. Not at MUSC. We are not laying off frontline workers. We're not laying off frontline nurses, nursing techs, respiratory therapists, doctors. Anyone that works on the frontline taking care of patients. We are not laying off. Speaker 19: (45:57) Can you give us some examples of who is being laid off then? For the lay folks who don't understand what's conserved frontline? Dr. Cawley: (46:04) Well, there are often people in the background that work background. Maybe a quality work, or some registries in the background. Billing folks, things like that. Things that are often in the background that during something like this, where we have to prioritize patient care, in an environment in which we must be fiscally responsible. We have to prioritize frontline workers. Henry McMaster: (46:32) Any more questions for Dr. Cawley at the moment? Speaker 20: (46:37) I have a question for Dr. Osman of Prisma Health. Henry McMaster: (46:39) Doctor. Speaker 20: (46:42) Where does Prisma Health stand on the COVID-19 testing backlog? Or is that caught up? Dr. Osman: (46:48) Our testing is a very caught up. As of today, we're working closely with DHEC, our internal labs. And then also with some of the private labs. So we feel pretty confident today that we're caught up on the vast majority of that testing. Henry McMaster: (47:02) Are there any more questions? Yes, in the back. Go. Speaker 21: (47:07) Governor, South Carolina got pretty much everything it had asked for out of the federal stockpile. Is it good to have a friend in a high place? I mean, why do you think South Carolina, while some other States didn't get as much, why do you think South Carolina kind of got everything you'd asked for? Henry McMaster: (47:20) Well, we've been asking for everything that's available. Of course, it is all... The way it is set out is by population, generally. And also include need. There are factors. But the administration, the Trump administration is working over time to get factories and producers to come online and switch from one thing to another. And we have a lot of them right here in South Carolina that are... It'll be announced, if they haven't already been announced. To people that are coming over and making mask and face shields. And tests and all sorts of things. It's an across the board effort. But we, we talk with the federal officials every day. So someone in our group is on the phone probably at every minute during the day talking to the federal officials. Being sure they know what our needs are. And that they are sending us everything that is within their power. Henry McMaster: (48:18) But a lot of the things that we need, we must get from the private market. And therefore we are just like everybody else. Just like the hospitals. We don't just get it from the federal government. So I assure you that our team is working around the clock to see that whatever we need we get. You remember a year or so ago the DHEC lab ran out just about of the reagent that's used for the test. Well, we got busy and made that need known. And overnight we got the reagent that we needed. Henry McMaster: (48:50) So our team is alert. And everything is available out there whether there's medical supplies, personal protection equipment, unemployment benefits, loans for small businesses, loans for sole proprietors, loans for 10 99 or unemployment. For those people, 1099 small businesses and others, that are usually not a part of the unemployment scheme. They are now. And we are working to be sure that the administration, those in charge of those federal agencies and regulations, know what we need here. And we are working vigilantly with our congressional delegation, Senator Graham, Senator Scott. All the others to see that anything is available. We will get. Yes. Right here. Speaker 22: (49:40) You made an order to close nonessential businesses but gun stores have stayed open- Henry McMaster: (49:44) I'm sorry. Say what? Speaker 22: (49:45) You've made an order to close nonessential businesses but gun stores have stayed open. Why are they considered essential? Henry McMaster: (49:54) Because there's a constitutional right to have bear arms. That's the second amendment. Speaker 19: (49:56) Awesome. Another staffing question. Are we losing all the nurses to frontline people to New York, and other places that might be paying more right now? And if so, are we tracking that? Henry McMaster: (50:06) Well were not... As has been explained we're not losing. But I let these gentlemen answer that question. Dr. Cawley: (50:14) We've seen some nurses and doctors go. I think they're wanting to go to a place where at the moment they're needed. So we've seen some low level. But I wouldn't say large numbers at this point. Speaker 23: (50:28) Dr Osman, can you comment on what types of staffers at Prisma have been furloughed? Are they nurses? Dr. Osman: (50:36) We're really in the same position as MUSC. None of our frontline doctors, nurses, technicians, people that are going to be providing care. I mean this is a challenging time for healthcare. But you know, we're taking the exact same approach that MUSC is. Speaker 20: (50:52) Is it impacting your readiness? Having those people laid off? Dr. Osman: (50:56) I don't believe it's affecting our readiness. I mean our frontline staff remains intact, committed, on the job. And it is not impacting the readiness at all. Speaker 23: (51:06) Do you have any layoffs or any other furloughs planned? Dr. Osman: (51:07) Those are out of my lane. Speaker 24: (51:12) Governor McMaster when will benefits from the Cares Act be available to folks? Henry McMaster: (51:17) Which one is the Cares Act? Speaker 24: (51:18) That's the one where they file for unemployment, and they are able to get those benefits. Henry McMaster: (51:25) That's 600 dollars? There's a 600 dollars regarding if you have the Coronavirus Assistance Act. And then you have the various Acts. But the the 600 dollars per person for unemployment insurance was not available until, I think it's just started now. Because of requirements that had not been met in Washington for the dispersion of those funds. But that's being met now. And those checks, that money, will be added to everyone's unemployment check who files for unemployment under the state unemployment system. Henry McMaster: (52:07) Now for others the 1,200 dollars per person. That is automatic from the Treasury Department. Which you have to be known as a as a tax payer. If you're not a tax payer then you can file as a tax payer. Need to hurry up and do it. If you haven't filed this year because the extensions this year. But if you haven't filed yet this year then what they will use is what was on the books last year. And that if you have a deposit account then it'll go directly into your bank account. If you don't have one, they'll have to send you a check. That's going to take a little. Henry McMaster: (52:45) All of those things are being handled. There were some restrictions and rules that had not yet been thought out and finalized in the government, the federal government. But if they haven't been, they all being and will be very soon. So those checks should start flowing immediately. We're working with the direct [inaudible 00:08:03], the Department of Employment Workforce and Department of Commerce. We were preparing to see what we could do ourselves in order to try to help fill that gap. But now, the checks, the money, the support should be coming. Henry McMaster: (53:18) And I say again there's ample avenues open. I urge everyone who's interested to go to those websites. The Department of Commerce, the Department of Employment and Workforce and look at those. And there's also loans coming through the private banks, as well, for small businesses. Yes ma'am. Ma'am. Speaker 25: (53:40) MUSC question. Are you still doing non-necessary surgeries to keep the cashflow coming in like gastric bypass? Or are there things that could be postponed? Dr. Cawley: (53:48) We postponed anything that can be postponed. We are only doing at this point in time emergent surgeries. That means emergencies. And we're only surgeries that we call urgent less than a week. Meaning really it's not an emergency but it should get done in the next week. We are doing it. What we're also finding though over the last... Because this has been going on three weeks. We have a third category called urgent less than a month. We are starting to get into that group. We're trying to push that off. But unfortunately this has gone on long enough that we're starting to see those. Anything over four weeks that is elected we are not doing. Speaker 24: (54:27) I have a question for Dr. Bell Dr. Bell what can we expect in the coming weeks? I know the Surgeon General has put kind of a grim outlook for the next two, three weeks for our nation. What specifically can we look for in South Carolina? What are the projections there? Dr. Bell: (54:42) Well, we have projections. But it's very, very difficult to really answer specifically what to expect. Our projections have already been commented on that are based on a variety of models. We're looking at everything from projecting out case reports based on who's been tested. We are looking at projections based on what other countries have experienced in a recovery phase. And so our preliminary projections based on one particular model suggests that we may see a peak in deaths in the first part of May. And from that information it gives us the ability to estimate hospitalization use, intensive care unit use, and ventilatory use during that period. So what that actual number is is hard to define because it's based on a range where there's a worst case scenario, and a best case scenario. And as General McCarty has already commented, we arrange, approximately in the middle of that, has been selected for this hospital planning. Speaker 23: (55:47) Dr. Bell. What's the status of the database from- Henry McMaster: (55:49) This has to be the last question. Speaker 23: (55:51) What's the status of the database for law enforcement in terms of where COVID-19 cases are? Speaker 26: (56:00) Director Nick Davidson will answer that. Director Davidson: (56:05) You are correct. We are working closely with our local partners, law enforcement, emergency management partners, I'll say. We started during this last weekend process through which we can enroll them electronically. And depending upon the type of system, there is not one 911 system around the state. There's many different types of 911 systems. And so some will have access through a query method, Internet based query method. Where at a 911 station if they are responding to an address they can enter it. And they can be told yes that's a recent COVID-19 residence where there was a recent COVID-19 positive individual. Or, no there was not at that same address. Director Davidson: (56:52) There's a model that we're pursuing. We have three... We have several counties that we're trying to work to pilot this with. And so in addition to the 911 center model, there's also a model where the responding unit could do the same thing, and provide a query. Director Davidson: (57:08) And then there's also where the larger counties... The counties with more 911 capabilities would be able to have a system that would more directly and integrate with their CAD based 911 system. So we have several models that we're working simultaneously throughout this week. We'll be piloting with several counties. And as the week comes to a close we should be, end of the week into the weekend, beginning to share with all counties that data electronically. But also I must urge in a very secure way. So that we're not just handing anybody a list, per se. It would be through a query based system for those that have a need to know. Henry McMaster: (57:48) One more in the back. Speaker 27: (57:51) Governor, one more simple question for you. Have you been tested hires yet? Henry McMaster: (57:53) No sir. I have not exhibited any of the symptoms. I'm following the protocol. I want to thank all of you for coming. Particularly today was focused mainly on our medical and health response. We appreciate the work. And please tell the doctors and the nurses and all the rest how much we appreciate what they're doing. Also, I want to remind you that law enforcement and first responders' already in a situation where they have to rush into danger not knowing what they're going to find. We're to trying to solve that problem as Mr. Davidson just mentioned. But for the ladies and gentlemen, and the citizens, the mamas and daddies and children. We are doing all we can. Henry McMaster: (58:36) And we're thinking every day of the people of the state... I want to remind people that it is the elderly that the facts, the science, and the data show are more susceptible to this. Those older people, particularly those with underlying conditions, the highest percentages of those up in the 90 percentage range. Those are the ones that are succumbing to this illness. Henry McMaster: (58:56) So I'd like to urge everyone to be careful about you, your mama, your daddy, your older people. Be careful about them. And remember that the social isolation involved in this... As it increases as we go along... The social isolation has an impact on people. And that's why mental health communities standing up. I assure finding every resource we have in South Carolina is thinking about nothing but the health and safety and the future of the people of South Carolina. And we thank all of you for being here again today.